Dexamethasone Dosing for Airway Swelling
For airway swelling, the recommended dose of dexamethasone is 10 mg intravenously every 6 hours for severe cases, or a single dose of 0.6-1.5 mg/kg for less severe presentations. 1, 2
Dosing Based on Severity
Severe Airway Swelling
- Initial dose: 10 mg IV dexamethasone 1
- Frequency: Every 6 hours 1
- Duration: Continue until resolution of airway edema, typically for at least 12-24 hours 1
Moderate Airway Swelling
- Initial dose: 10 mg IV/PO dexamethasone 1
- Frequency: Every 12-24 hours
- Duration: Until resolution of symptoms
Mild Airway Swelling (e.g., Croup)
- Dose: 0.6 mg/kg (single dose) 3
- Route: Oral or intramuscular
- Maximum dose: Generally not to exceed 10 mg
Special Considerations
Post-Extubation Airway Edema
- Start steroids as soon as possible in patients at high risk of inflammatory airway edema 1
- Continue for at least 12 hours 1
- Single-dose steroids given immediately before extubation are ineffective 1
- All steroids appear equally effective if given in adequate doses (equivalent to 100 mg hydrocortisone every 6 hours) 1
Pediatric Dosing
- For croup: 0.6 mg/kg as a single dose (oral or IM) 3
- This is effective for most children with upper airway obstruction between 6 months and 6 years of age
Administration Guidelines
- For rapid effect in acute airway obstruction, use IV or IM routes 2
- IV/IM dexamethasone produces high blood levels within 15-30 minutes of administration 2
- For less urgent situations, oral administration is acceptable
Adjunctive Therapies
- If upper respiratory obstruction/stridor develops, consider nebulized adrenaline (1 mg) to reduce airway edema 1
- Heliox may be helpful but limits the FiO₂ 1
- Position patient upright and administer high-flow humidified oxygen 1
- End-tidal carbon dioxide monitoring is desirable 1
Monitoring and Follow-up
- Monitor for:
- Resolution of stridor/respiratory distress
- Oxygen saturation
- Work of breathing
- Potential side effects (hyperglycemia, especially in diabetic patients) 4
Important Caveats
- The steroid effect is local and directly proportional to the concentration in the inflamed tissue 2
- For maximum effect in upper airway obstruction, steroids should be delivered to the inflamed tissue in high concentration with minimal delay 2
- The risk of harm from steroid therapy of 24 hours or less is negligible 2
- Steroids reduce inflammatory airway edema but have no effect on mechanical edema secondary to venous obstruction (e.g., neck hematoma) 1
- In cases of severe refractory airway edema not responding to steroids, consider securing the airway with intubation 5